Tuesday, January 11, 2022

Delaware: Hospitals Invoke Crisis Standards of Care - Gov. Orders Indoor Mask Mandate

 

#16,500

Despite its reputation for being `milder' than Delta, Omicron - being so much more transmissible - is hitting many states as hard, or harder, than earlier variants.  While your individual risk of being hospitalized or dying from Omicron may be lower - particularly if you are vaccinated - the risk to society remains high. 

In early December, in More U.S. Hospitals Inch Towards Invoking Crisis Standards of Care, we looked at the rising number of hospitals adopting emergency protocols to deal with overwhelmed ERs, increasing admissions, and growing staff shortages.

We've explored the impact of these protocols often in the past few months (see The Realities Of Crisis Standards Of Care), but in short it can mean hospitals are allowed - under certain dire circumstances - to ration care (including access to ventilators, ICU beds, etc.), invoke DNR (Do Not Resuscitate) protocols (see Standards Of Care During A Pandemic: CPR & Cardiac Arrest), and even turn some patients away. 

Over the weekend, in Colorado Reactivates Crisis Standards of Care For EMS Providers, we looked at Omicron's impact on EMS services out west, while 10 days ago we looked at its impact in the Northeast (see Maryland: Multiple Hospitals Activate Crisis Standards of Care).

It is likely that most regions of the country will see similar pressure from Omicron in the weeks ahead. While today's report focuses on Delaware, they are far from alone in feeling the impact of this latest COVID wave. 

First, excerpts from a press release from ChristianaCare, which operates the largest hospital system in the state of Delaware, announcing their invocation of Crisis Standards of Care.  Followed by a press release from the Governor, ordering indoor mask wearing and deploying National Guard troops to assist in hospitals. 


ChristianaCare Implements Crisis Standards of Care

(WILMINGTON, Del. – January 10, 2022)

To meet the unprecedented demand for hospital and health care services amid the current surge of COVID-19, ChristianaCare has implemented Crisis Standards of Care.

Crisis Standards of Care are used in times of emergency to guide decision-making when the demand for care surpasses the available resources, and contingency strategies designed to maintain conventional processes of care have been exhausted. They provide a framework in which health care providers can modify processes or change the way resources are allocated in order to care for patients with the highest need in conditions when it is no longer possible to deliver care according to normal standards. Amid the current COVID-19 surge, many health systems across the country have adopted these standards. Health systems across the United States are increasingly finding it necessary to implement Crisis Standards of Care as the current surge of COVID-19 stretches the health care system beyond its capacity.

“At ChristianaCare, we take care of people. Our commitment to our community is unwavering,” said Janice Nevin, M.D., MPH, president and CEO. “The health care system is under unprecedented strain. Never have there been this many people in our community who need hospitalization, emergency care and other health care services. We have taken this step to implement Crisis Standards of Care so that our caregivers have the flexibility and decision-making tools they need in order to deliver care to patients with the highest need at this time when the demand exceeds all available resources.”

Crisis conditions exist when resource challenges, including staffing, space and supplies, place such a burden on the health system that it must modify the practice standards in order to provide care.

Crisis Standards of Care enable greater flexibility for health care providers in decision-making in areas such as:
  • Advancing different care models.
  • Simplifying documentation requirements.
  • Changing workflows.
  • Changing admission or discharge criteria.
  • Modifying surgical and other procedural and diagnostic schedules.
  • Adjusting how supplies are allocated.
  • Changing how treatment resources are distributed.
  • Redeploying clinical and non-clinical staff.
  • Adjusting staffing standards including, among other things, staffing ratios, return to work, annual educational requirements or credentialling requirements.
  • Limiting availability of non-urgent services.
  • Adapting documentation, reporting and approach to regulatory requirements.
Decisions regarding the use of limited resources will be made in a just, equitable and transparent way, and our caregivers will engage with patients and their family members about expectations and options of care. ChristianaCare will rely upon guidelines adopted by the National Academy of Medicine and the Delaware Division of Public Health in its Crisis Standards of Care Concept of Operations Plan, and also guidelines under consideration in Maryland.

“Over the past two years, we have learned and adapted at every step throughout this pandemic,” said Ken L. Silverstein, M.D., MBA, chief physician executive. “Through this time, we have deployed surge plans and taken many steps to stave off the need to implement Crisis Standards of Care. But the time has come when there just are not enough resources available to meet the growing demand. This is a pivotal moment when everyone needs to recognize the seriousness of the situation our community and our health system is in.”

Unprecedented Demand Driven by COVID-19

While the demand for health care includes patients with and patients without COVID-19, the high rate of COVID spread in the community is the single most important cause of this current crisis.

For weeks, ChristianaCare has been operating at over 100 percent of capacity in its hospitals, emergency departments, urgent care centers and practices. Approximately 40 percent of all patients at Christiana Hospital, Wilmington Hospital and Union Hospital are COVID-positive. The vast majority of these COVID-19 patients are symptomatic and were admitted because of COVID or require a higher level of care because of the impact of COVID on their health.

Additionally, as community spread has surged to record numbers, and as the highly contagious omicron variant has become the dominant variant, breakthrough cases among vaccinated people are becoming more common.

Dr. Silverstein urges the community to understand that the significant number of unvaccinated people continues to be the primary driver of this very serious situation.

(SNIP)

What Can the Community Do to Help?
  • Everyone age 5 and older should get vaccinated for COVID-19.
  • Everyone age 12 and older should get a booster dose when they are eligible.
  • Practice COVID-19 safety: Wear a mask, avoid gathering indoors, practice social distancing and wash hands frequently. It’s important to follow these steps even in places where safety guidelines are relaxed or where safety instructions aren’t posted.
  • Do not go to the emergency room unless you are experiencing a medical emergency.
  • If you’re sick, assume it’s COVID-19, and stay home except to get a COVID test. Most people with COVID-19 have mild illness and can recover at home without medical care. Get rest and stay hydrated. Take over-the-counter medicines, such as acetaminophen, to help you feel better. Call your doctor if your symptoms are severe or worsening. Get care or call 911 if you have trouble breathing or have any other emergency warning signs, or if you think it is an emergency.
  • Do not go to the emergency room for a COVID test. Find test availability at the State of Delaware website, the State of Maryland website, the State of Pennsylvania website or the State of New Jersey website.
  • Patients with serious illness and injury should continue to access needed care at our hospitals and emergency departments. Those with less serious conditions should avoid the emergency departments and seek care from their primary care provider or one of our many urgent care centers. Patients can expect longer wait times for all services and limitations on visitors.
Learn more at https://christianacare.org/coronavirus/


And from the Governor's office:


Public mask mandate takes effect at 8:00 a.m. on Tuesday
School mask requirement also extended
Additional members of the Delaware National Guard deployed to assist with non-clinical operations inside Delaware hospitals

WILMINGTON, Del. – Governor John Carney on Monday signed a revision to the State of Emergency declaration, requiring Delawareans to wear masks in indoor public settings, including convenience stores, grocery stores, gyms, restaurants, bars, hair salons, malls, and casinos.

The mask requirement takes effect at 8:00 a.m. on Tuesday, January 11. Also on Monday, Governor Carney ​announced plans to extend the school and child care facilities mask requirements, and deployed additional members of the Delaware National Guard to assist with non-clinical operations inside Delaware hospitals.

Click here to read Monday’s revision to the State of Emergency.

Click here to read the full State of Emergency declaration.

“Our hospital systems are facing a crisis-level situation with record numbers of Delawareans seeking emergency care. We need all Delawareans in the fight as we face this winter surge of COVID-19 to make sure our hospitals are not overrun,” said Governor Carney. “I know we’re all exhausted by this pandemic. But at the level of hospitalizations we’re seeing, Delawareans who need emergency care might not be able to get it. That’s just a fact. It’s time for everyone to pitch in and do what works. Wear your mask indoors. Avoid gatherings or expect to get and spread COVID. Get your vaccine and, if eligible, get boosted. That’s how we’ll get through this surge without endangering more lives.”

Looking at the hospital situation in Central Florida where I live, I'm seeing a steep increase in Hospital Volume Bypass and Total Diverts, reaching levels we haven't seen since last September's Delta wave.  

All of which makes anything you can do to avoid ending up in the hospital in the weeks ahead, well worth the effort. 

If you aren't vaccinated against COVID and the Flu, considered that a priority. Wear a face mask in publish, and avoid crowds if you can.  And if you are sick, or are not fully vaccinated and have been exposed, please stay home under the CDC's revised guidelines. 

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